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General Form No. 96-a <br />Prescribed by the Slate Board of <br />Accounts of Indiana. Revised 1949, <br />Standard Questionnaires and <br />Financial Statement for Bidders <br />Prescribed by <br />THE STATE BOARD OF ACCOUNTS OF INDIANA <br />For use in investigating and determining the qualifications of bidders on public <br />construction when the aggregate cost of any such work or improvement will be Five Thousand <br />Dollars or more. <br />These statements to be submitted under oath by each bidder with and as a part of his bid, as provided <br />by Chapter 306, page 1248, Acts of 1947 <br />Submitted to City of South Bend — Board of Public Works <br />By Walsh & Kelly, Inc. <br />Address 24358 SR 23, South Bend, IN 46614 <br />Date submitted May 23", 2017 <br />Filed <br />A.E. BOYCE CO., MUNCIE, IND. <br />fA Corporation <br />1 <br />